were same. Fig. 1. Diagramatic representation of peripheral calcification types of the thyroid tumors. A. Type 1: peripheral nodular calcification

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2 Fig. 2. A 38-year-old man with papillary carcinoma. Longitudinal sonogram of right thyroid lobe shows a solid mass with Type 1 peripheral nodular calcification. The histopathologic results of preoperative gun biopsy and surgery were same. A B C Fig. 1. Diagramatic representation of peripheral calcification types of the thyroid tumors. A. Type 1: peripheral nodular calcification B. Type 2: peripheral smooth rim calcification C. Type 3: peripheral irregular rim calcification Table 1. Comparison of Pathologic Results between Preoperative Biopsy and Surgery NO. Type Preoperative biopsy Bx method Surgical results 01 1 Papillary carcinoma Gun Papillary carcinoma 02 1 Papillary carcinoma Gun Papillary carcinoma 03 1 Follicular neoplasm Gun Follicular adenoma 04 1 Follicular neoplasm Gun Follicular adenoma 05 1 Papillary carcinoma Gun Papillary carcinoma 06 2 Benign lesion FNA Papillary carcinoma 07 2 Papillary carcinoma Gun Papillary carcinoma 08 2 Nodular hyperplasia Gun Papillary carcinoma 09 3 Suggestive of papillary carcinoma Gun Papillary carcinoma 10 3 Atypical cell Gun Papillary carcinoma 11 3 Papillary carcinoma Gun Papillary carcinoma 12 3 Atypical cell Gun Papillary carcinoma 13 3 Papillary carcinoma Gun Papillary carcinoma 14 3 Papillary carcinoma Gun Papillary carcinoma 15 3 Follicular cell lesion Gun Nodular hyperplasia 16 3 Suspicious papillary carcinoma FNA Papillary carcinoma 17 3 Atypical cell Gun Papillary carcinoma 18 3 Nodular hyperplasia Gun Papillary carcinoma 19 3 Benign lesion/ Papillary carcinoma Gun Papillary carcinoma 20 3 Benign lesion Gun Papillary carcinoma 21 3 Papillary carcinoma Gun Papillary carcinoma Bx: biopsy, FNA: fine needle aspiration biopsy 402

3 Fig. 3. A 35-year-old woman with papillary carcinoma. Longitudinal sonogram of right thyroid lobe shows a solid mass with Type 2 peripheral smooth rim calcification. The histopathologic results of preoperative gun biopsy and surgery were same. 403 Fig. 4. A 36-year-old woman with papillary carcinoma. Longitudinal sonogram of right thyroid lobe shows a solid mass with Type 3 peripheral irregular rim calcification. It was diagnosed as atypical cell at automated gun biopsy and was proved to be papillary carcinoma at surgery.

4 3. Seiberling KA, Dutra JC, Grant T, Bajramovic S. Role of intrathyroidal calcifications detected on ultrasound as a marker of malignancy. Laryngoscope 2004;114: Kakkos SK, Scopa CD, Chalmoukis AK, Karachalios DA, Spiliotis JD, Harkoftakis JG, et al. Relative risk of cancer in sonographically detected thyroid nodules with calcifications. J Clin Ultrasound 2000;28: Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, Kawamoto H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 2001;136: ,,, ;13: Iannuccilli JD, Cronan JJ, Monchick JM. Risk for malignancy of the thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med 2004;23: Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB Jr. Common and uncommon sonographic features of the papillary thyroid carcinoma. J Ultrasound Med 2003;22: Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178: Tessler FN, Tublin ME. Thyroid sonography: current applications and future directions. AJR Am J Roentgenol 1999;173: Komolafe F. Radiologic patterns and significance of thyroid calcification. Clin Radiol 1981;32: Taki S, Terahata S, Yamashita R, Kinuya K, Nobota K, Kakuda K, et al. Thyroid calcifications sonographic patterns and incidence of cancer. Clin Imaging 2004;28: Yamana K, Nakano R, Kinoshita T, Morimatsu M, Nakashima T. Ultrastructure of anaplastic carcinoma with large calcification in the thyroid gland. Acta Pathol 1984;34: Klink GH, Winship T. Psammoma bodies and thyroid cancer. Cancer 1959;12: Katz JF, Kane RA, Reyes J, Clarke MP, Hill TC. Thyroid nodules: sonographic-pathologic correlation. Radiology 1984;151: Park CH, Rothermel FJ, Judge DM. Unusual calcification in mixed papillary and follicular carcinoma of the thyroid gland. Radiology 1976;119: Khoo ML, Asa SL, Witterick IJ, Freeman JL. Thyroid calcification 17.,,,,,. and its association with thyroid carcinoma. Head Neck. 2002;24: ;45: ,,,,. 18. Taki S, Kakuda K, Kakuma K, Annen Y, Katada S, Yamashita R, et. Korean J al. Thyroid nodules: evaluation with US-guided core biopsy with Otolaryngol 2004;47: an automated biopsy gun. Radiology 1997;202:

5 Patterns and Significance of Peripheral Calcifications of Thyroid Tumors seen on Ultrasound 1 Min Sook Kwak, M.D., Jung Hwan Baek, M.D., Yoon Suk Kim, M.D., Hyun Jo Jeong, M.D. 1 Department of Radiology, Daerim St. Mary s Hospital Purpose: We wanted to analyze the peripheral calcification patterns of thyroid tumors that were seen on ultrasound and we also wanted to evaluate the clinical usefulness of the peripheral calcifications of the thyroid tumors. Materials and Methods: We retrospectively analyzed 21 peripheral calcifications of the thyroid tumors of 18 patients; these were histopathologically confirmed by fine needle aspiration biopsy, automated gun biopsy and surgery. The peripheral calcification patterns were categorized into three types: type 1, peripheral nodular calcification, type 2, peripheral smooth rim calcification, and type 3, peripheral irregular rim calcification. The histopathologic results obtained during surgery, fine needle aspiration or automated gun biopsy were compared. Results: Of the total 21 peripheral calcifications of thyroid tumors, 5 cases showed as being type 1 (24%), 3 cases showed as being type 2 (14%) and 13 cases showed as being type 3 (62%). Of the total 21 peripheral calcifications of the thyroid tumors, 18 were histopathologically confirmed as papillary carcinoma (86%). Among the type 1 peripheral calcification patterns, 3 cases were coincidentally diagnosed as papillary carcinoma and 2 cases were follicular neoplasm on the preoperative biopsy results and on the surgical results. Two cases of type 2 peripheral calcifications (67%) and three cases of type 3 peripheral calcifications (23%) were diagnosed as benign lesions upon preoperative biopsy, but the postoperative results were papillary carcinoma. Conclusion: Peripheral calcifications of thyroid tumors are important feature that suggest malignancy together with the microcalcification and peripheral calcifications of the type 2 and type 3 patterns, and these lesions may be difficult to accurately diagnose with using only biopsy. Index words : Thyroid, neoplasms Thyroid, US Calcification Address reprint requests to : Min Sook Kwak, M.D., Departement of Radiology, Daerim St. Mary s Hospital Daerimdong, Yeongdeungpo-gu, Seoul , Korea. Tel Fax

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